We recommend the transabdominal subcostal approach in patients with Morgagni hernia for surgical exposure, easy repair of the hernia sac, and low morbidity.

Chest wall hamartomas are extremely rare. Frequently mesenchymal hamartomas are presented as a single mass and contain some primitive mesenchymal elements such as chondroid and trabecular bone structures. A 60-year-old man presented to hospital with chest pain. Thirteen years earlier, his CXR and thoracic CT showed three masses on the right and two masses on the left, but he had not received any treatment thereafter. His CT showed the same masses present 13 years earlier, but they were bigger and right thoracotomy was undertaken. At thoracotomy, two sections of the mass in the right posterior mediastinum and one section of the mass in the right apex were excised. They had an occasional bloody appearance and contained small cystic areas, and some areas were extremely hard. Microscopic examination showed that the lesions consisted of mature adipose tissue, a large number of veins of different diameters and collagen tissue. Besides, primitive mesenchymal elements, lymphoid cell accumulations and trabecular bone structures were seen focally. Bilateral chest wall hamartomas are extremely rare and may be confused with malignancy.

BackgroundTraumatic asphyxia is probably much more common than the surgical literature shows and should always be kept in mind as a possible complication of injuries of the chest and abdomen. AimsTraumatic asphyxia or Perte’s syndrome results from a severe crush injury causing sudden compression of the thorax. During a 3-year period, we treated five cases of traumatic asphyxia, which we report in this manuscript.MethodsThe patients were all male, ranging in age from 26 to 64. They suffered different types of crushing injuries: industrial accidents in two patients, run over by motor vehicles in two patients, and a farm accident in one patient. Most of the patients suffered some associated injuries, including fracture of the sternum in one patient, fracture of the right clavicle in one patient, and bilateral hemopneumothoraces in one patient. ResultsThe treatment included bilateral chest tube thoracostomy in one patient, and the others required supportive treatment. There was no mortality.ConclusionTreatment for traumatic asphyxia is supportive, and patient recovery is related to the generally associated injuries. Traumatic asphyxia should always be kept in mind as a possible complication of injuries of the chest and abdomen.

Solitary fibrous tumor (SFT) of the pleura is an uncommon neoplasm with non-specific symptoms and non-pathognomonical radiological findings. Surgery allows establishment of a definitive diagnosis as well as a cure of the disease. The role of radiotherapy or chemotherapy in the management of the disease is unclear because of the rarity of the disease and the successful results of the surgical treatment. Long-term clinical follow-up may be useful for the patients with SFT because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation. We reported a 66-year-old woman with recurrence of SFT in the right lung, which had significant response to external thoracic radiotherapy.

Infections with Beauveria bassiana are extremely rare in humans. A 51-year-old man was admitted to hospital with the diagnosis of lung adenocarcinoma. Thoracic wall resection with lobectomy was applied and empyema has developed after prolonged air leakage. B. bassiana was isolated in pleural fluid. The patient improved without antifungal therapy after thoracotomy with securing of air leakage.

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Upper lobe fibrobullous disease is a well-known finding in advanced stages of ankylosing spondylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe segmentectomy and an aspergilloma was detected. Histologic findings were in favour of necrotising Aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising Aspergillus pneumonia. In the literature, there are recently published series of pulmonary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnormalities are quite frequent. Although the clinical significance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflammation. Here, we review the series of pulmonary HRCT in AS patients.

In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.